I'm telling you this is just too much. The office computer is old. The health insurance companies have to decide which plan a physician participates with and as a result it becomes very difficult to obtain a referral from the health insurance company. There has to be a simpler way of doing things. I know people get sick or they require many visits to a physician and the health insurance company just wants to make sure that the patient is being seen for necessary and valid reasons in order to pay money out to the physician for merely chatting all day(please your staff wants to leave to do other things, these lengthy conversations ain't about medical stuff or about the patient in the room. They can't be anyway, I don't know of a doctor who knows that much or a patient who is willing to listen to how sick he or she really is.) and not go just based on what the medical billing people decide to provide as information. It's understood that if it is documented that a patient at least by referral is seeing a physician then, it becomes a valid visit. Of course this is a good way to find out if a physician is in network with a patient's health plan and if not then they have to find someone who is. The health insurance companies need to know that they have to try and work with the front desk people of a medical office. This at times is hardly easy. You try and understand us and we have to try and understand you. I want to implement what is known as a referral log. You ask, what is this and if you're doing this then why not just do the referral? Because, by doing the referral log it will take less time. For example: Bemblem and Docsford Health has all kinds of health insurance plans and different websites especially if for some reason a patients is categorized under Moneyfeore. Do you realize what the front desk has to go through to get a referral? Anyways, the referral log under Bemblem- you just log in and go to referral log- then put in the patients health insurance ID and their date of birth. Their demographics come up and then you just enter the physician they are going to see. You can do this by entering a Name, NPI or tax ID and you just hit enter and this will automatically bring up the physicians information- and you then select create referral log. In doing this it will provide a patient with enough visits for three months and that log information will be stored on the health insurers website such as Bemblem. It will provide you with a confirmation number and you can always go to the referral log to view the referral logs that have been created for each patient. This expedites the referral process and there is nothing to print out and fax over. The specialists office can go online and check and this will save a lot of time. Why? Because you don't have to provide how many visits, or select specialist or consult or even why the patient is seeing a physician. As the health insurance company should already have that information as provided from the EMR when the billing is done. Just trying to eliminate redundancies here and this would help with things somewhat. If a physician is out of network, the health insurance website will indicate that and another physician will have to be selected, especially if they are under the same Tax ID. Insurance companies are the Type-O to the Jesus of Type-AB(able). Nobody is perfect, but you have the medical office front desk just hanging in!

All of this talk about retirement and not enough put into practical solutions for it. There once was a time when people lived in their homes until they were very old and I mean really old. These old people did all the things young and middle aged people do. What is that you ask? These older people grew plants and food in the summer and they even mowed their own lawn. They also shoveled enough snow to get out of their houses and driveways. At least to me illness was a see-saw of events in that either you were a sickly person or you were not sick or didn't have much of an ailment to speak of at all. Eating oats and wheat were popular and drinking loads of milk, or orange juice kept people around. It was a simpler way of life and there were no "people stressors" because everyone had a place. The anglos did their thing, and the non-anglos just learned how to hang in there. Then as a "place at the table" became uncommon in that "just hanging in there" would mean that people often went without food because it was considered a luxury. The search for employment to afford food meant that there would be "people stressors" because there were those that would be seen as "out of place" as opposed to in one. You have to ask yourself, what kind of person would allow someone to go without food by not paying them enough to afford it? It would seem to me that anglos feel that food among other things is a luxury, to put the person in that situation. Which brings me to my next point, why in the would would the USA have an economy designed to make food, clothing and shelter or housing a luxury? When one looks at his or her life they wish that many things were different, just as people are despite the anglo-saxon attempts to make it all one by acceptance. And, unfortunately the USA is unhealthy as a result. The colors that came to be are unique and that should be what makes the USA a great nation. But we decide to be like other third-world countries and pout about who is going to save whom in terms of religion, when that answer should be somewhat apparent. Yes, we all have sacrifices we must make but, I must say that when it comes to survival the anglos and anglo-saxon's have also made it apparent who is entitled and who is not. This means that they have admitted to their social injustices towards people and humanity by doing what they have done to have created this kind of predicament and existence for such people. Food, shelter and housing is not a luxury and should not be a "let's make a deal" with regards to one's spiritual humanism. I will do all I can for my troubles, but who do y'all "seek" when trying to create wine? Any money paid in part or whole for retirement housing or assistance of care in any way for food, clothing, and other necessities should be the standard as plans or programs should be implemented and adjusted so that everyone can afford one and be able to use it during retirement. This would would prevent starvation and homelessness, since social security will not be enough. This should be the wrath of the people in the USA, and not what mortal you seek as an offering of greed so that you can continue to be neglectful to humanity and spiritually turned off because of warped remote control values.

To me happiness is the greatest raise or promotion. I tell you if I were happy there is so much I could do with it. But for now and in this misery I continue to function and as for this weeks blog I want to talk about high blood pressure otherwise called hypertension. When a blood vessel to the brain becomes narrowed,blocked,clogged or it can even burst; this prevents blood and oxygen from getting to the brain. When the brains supply of oxygen and blood are not met then that results in what is known as a stroke. High blood pressure causes damage to the arteries and eventually a stroke can occur if one does not consider diet, exercise and of course medications or supplements to prevent it. In heart valve replacement it is not uncommon to be affected by hypertension. Peripheral arterial disease is caused by the narrowing of blood vessels due to atherosclerosis or hardening of the arteries. This is important because peripheral arterial disease is one that affects the blood flow from the arms, legs and stomach. A lack of blood flow in the arms or lower limbs due to a clot or fatty deposit can make one susceptible to a stroke. In heart patients who have undergone heart valve replacement and have un-monitored hypertension, a test called the ankle-brachial index or ABI should be done, as this test measures the systolic pressure in the arms and the ankles. This can help to determine the presence of peripheral arterial disease especially if a patient is unable to walk on a treadmill. High blood pressure in general contributes to making the heart do more and thus putting a lot of strain upon it. And of course here goes my next thing... A patient with peripheral arterial disease already has enough problems especially if the condition was caused by hypertension or by it being un-monitored before or after heart valve replacement surgery. Daily ankle-brachial index monitoring can be helpful to patients so that they can avoid stress to the lower limbs that can affect arteries and cause rupture or pressure and eventual stroke. This can be made a whole lot easier by patients and even physicians offices to be able to purchase blood pressure and ankle-brachial index machines that are all in one so to say. The results are automatic as you measure blood pressure and ABI in one visit and in one exam room(for physicians with the use of a laptop) and a patient can also either keep a log of his or her blood pressures or ABI's or they can use a laptop also to have the results sent to their physician. They say health is wealth, but being able to take care and monitor it inexpensively and on one's own can make for a happy medium.

Isn't this something, a certain company now wants to charge medical offices for something I have been doing darn near every month. They want an awful lot of money for something I have actually been doing. The only thing different here is that we used to submit this "quality measure" information to CMS directly through their website for incentive payment. Now things are somewhat rearranged and this new information having more to do with quality measures and advanced care has affected the way physicians get paid through Medicare as a result of reduced payments or penalty because the physician must show a demonstrated use of such measures as required by Medicare. Medicare does not have a designated "free" or "no payment required" website to use so that all of this merit based incentive payment system or MIPS as it is called, can be submitted to it. As a result there are several websites out there that will allow a physician or a group of, to enter this information in order to avoid the Medicare penalty in payment. This means that a medical office that is barely making it must pay additional fees and costs so that they can submit their quality participation information so that they do not incur large penalties over the years. Y'all probably think I'm stupid and should just ask the bosses in charge for the money that this company want to charge them for the work that I have already been somewhat doing. Now, them Anglos know that some medical offices have been doing this already and they know how to get extra money out of them by offering to obtain and do this report tracking within the EMR. They will just take the reports that some front desk medical worker grunt has already done and then use that information and get paid for it. So am I worth it? Look at all of this nonsense! This MIPS program via Medicare should really have a website that is free as they did before through CMS. More importantly CMS should have already designed a system of things so that a physician or medical office could link their EMR to a CMS merit based reporting system to obtain all of this information. This has really become something else, the front desk medical staff is real busy and I mean really busy. They got all of this stuff going on and they have to in addition to the sordid requests from the physicians, patients, along with insurance company requirements; obtain quality measures reports and then enter the information into a registry that charges a fee. Now there should be no double dipping here! If a front desk medical office worker obtains the reports themselves then they can just then enter the information into the MIPS website that they are using-this should only be one fee paid to the MIPS website. They can avoid the very large fee that a company is requesting because the front desk medical worker is already obtaining what is needed and they should be able to avoid another fee since they are providing the information to the MIPS website themselves. My whole problem with this is that if every body is out to make a few bucks, by reporting incentives and their submission, then once Medicare gets all of this information and pays out, How much money is a physician making afterwards? To avoid the reduction in payment and of course depending on how many Medicare patients a physician or medical office has regarding EMR companies who want to charge for this sort of thing; it sometimes may not be worth it. A medical office pays out for all of this services, but where is the profit or financial sustainability to justify what is being done? Who really benefits? It will allow insurance companies to pay less and eventually premiums and deductibles will increase so that hospitals, medical facilities and medical offices can continue to exist.